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Old 08-24-2010, 05:46 AM   #2
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi again Baptista,

I'll insert some thoughts in green.

Originally Posted by Baptista View Post
I am looking for information related to issues of PC diagnostic and treatment after Salvage Radiotherapy.
In accordance to a report by R. Choo M.D. from Mayo Clinic, researches have been few, uncompleted or null to identify the best practice to treat cases of patients experiencing a relapse after major treatments.

The Mayo Clinic has been a leader in so much of medicine, and their work has included major contributions to prostate cancer. However, I'm rather surprised that your doctor would make that statement, especially as the Mayo Clinic has been quite involved in hormonal blockade therapy through the work of Dr. Horst Zincke (initial combo surgery plus blockade for higher risk cases).

Hormonal blockade IS and has for a long time been established as the standard treatment after surgery and/or radiation, or other local treatment has failed. There has been an abundance of research published on hormonal blockade therapy as well as other forms of hormonal therapy for prostate cancer. Moreover, there has been work on triple androgen deprivation (triple hormonal blockade) that has documented impressive success; some of it has been published, but some of it has been only informally published. My impression is that the team that has taken the lead here is the Scholz, Strum, Lam group. Dr. Charles "Snuffy" Myers' book "Beating Prostate Cancer: Hormonal Therapy & Diet," is precisely on your topic. Dr. Strum's book "A Primer on Prostate Cancer - The Empowered Patient's Guide, has a long and expert section on hormonal therapy, including a table showing impressive results from his practice using triple blockade after surgery, radiation, or both.

The National Comprehensive Cancer Network updated its guidelines last year for all kinds of situations involving prostate cancer. I haven't checked their update on your situation, but I'm confident it will feature hormonal therapy. If you check and find that's not so, please let us know on the board.

In my case (ten years of survival), I had RP followed by SRT and now I expect to continue the “standard protocol” with ADT, however, the only indication of recurrence is a rise of the PSA (I have no prostate). My doctor told me that his cutoff (level) for starting the ADT is a PSA=1.0.

A resent MIR was negative for metastasis and I am asymptomatic, surely the rise in PSA (0.05 to 0.79) validates the presence of prostatic cells but not recurrence of the cancer. Never the less I am skeptical to accept the idea of treating a “number” rather than a symptom.

I too would try to figure that out, but to me the key clue would be whether the PSA is rising at that tell-tale exponential rate, in other words, doubling in a period of time that was the same: for example, from .1 doubling to .2 in, let's say, five months; then .2 doubling to .4 in about another five months; then doubling from .4 to .8 in another five months; and so on. In contrast, some up and down PSA activity, or substantially inconsistent doubling times, would raise doubts about cancer recurrence, as I understand this as a layman.

I went through this with my own case, hoping that my very high-risk might still respond to a single round of triple hormonal blockade (31 months for me) like virtually all the low-risk cases - indefinitely long cancer control with the aid of finasteride or Avodart maintenance, at least in the practices of a couple of doctors. Their trigger point for restarting blockade was a PSA around 10 - a trigger that was higher than used by some of their expert peers. What was not clear to me was that the steady exponential rise in my PSA was a solid sign of recurrence.

I would like to receive opinions and accounts of cases with similar conditions. Can anyone in this forum help me?

Appreciated for any available information,

I hope you get some helpful responses.

Take care,